New Concept of the KPS Bipolar Radial Head Prosthesis
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1 New Concept of the KPS Bipolar Radial Head Prosthesis Stanisław Pomianowski, Mariusz Urban, Dariusz Michalik, Marcin Błoński, Jan Szneider, Maciej Wleklik, Marta Maksymowicz, Sławomir Kwapisz, Katarzyna Białecka,
2 KPS replacement
3 KPS - vitallium/uhmwp implant Pomianowski, Chir Narządów Ruchu Ortop Pol, 1997
4
5 Bipolar implant can be as effective as a monoblock (non-bipolar) radial head prosthesis in restoring valgus stability of the elbow after injury to the medial collateral ligament
6 Wright KPS Judet
7 All implants did provide some stability in the MCLdeficient elbows. None of the prostheses restored stability to the same degree as a native radial head, particularly in forearm pronation. Pomianowski S., JBJS (Am), 2001
8 Comminuted radial head fractures - ORIF not possible Radial head replacement is not contraindicated in young patients Elbow dislocation with concomittant radial head fracture (Mason IV) Monteggia fracture with radial head fracture Coronoid fractures type II and III Tear of anterior band of medial collateral ligament (MCL) and/or lateral ulnar collateral ligament (LUCL) Essex-Lopresti fracture Complex injury and instability
9 Synovitis of the elbow joint Damage of the cartilage of the humerus capitellum
10 Pronation of the forearm Anterolateral between CET and ECRB, ECRL and BR Capsule incision above Lateral Collateral Ligament Complex
11 133 KPS bipolar radial head replacements between 1998 and 2009, 110 were evaluated 5 Link radial head replacements
12 Function Points Definition Points Pain 45 None Mild Moderate Severe Motion 20 Arc > 100º Arc º Arc < 50 degrees Stability 10 Stable Moderate instability Gross instability Function 25 Comb hair Feed Hygiene Shirt Shoe Total score Excellent 90 Good Fair Bad < 60
13 MEPI final score: 63% Excellent (68) Good (28) Fair (8) Bad (6) 25% 7% 5% excellent good fair bad
14 Implantation of KPS bipolar radial head prosthesis is a reasonable alternative to radial head excision allowing better clinical outcome what has been demonstrated in our experience with 87% (96/110) of excellent and good clinical results
15 321 KPS bipolar radial head prostheses and 5 monoblock LINK prostheses were implanted 25 KPS prostheses were removed, in 10 cases due to synovitis of the elbow joint In 8 of 10 cases UHMWP debris were found
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17 Operation brachial plexus block, Esmarch Antero-lateral approach Mason type III radial head fracture Right Bipolar Radial Head Replacement type KPS (22/12) Redon drainage, suture, dressing
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19 9 years after the operation
20 Operation The same surgical approach Chronic synovitis, cartilage damage Endoprosthesis removal, synovectomy - histopathology
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23 Histopathology
24 7 weeks after the operation
25 7 weeks after the operation Painless elbow Flexion 140, extension 15, full rotation of the forearm Valgus angle 30 (Left elbow 20), stability 5 points (MEPI) No other complications Result 95 points (MEPI)
26
27 Female J.M., 27 years old In 1998 left elbow injury Pain, restriction of movement MEPI - 35 points
28 Preoperative X-ray Diagnosis - Radial head fracture type Mason III
29 Postoperative X-ray
30 Excellent (MEPI points) Painless movement Flexion/Extension 130/0 Supination/Pronation 70/70
31 19 years follow-up
32 19 years follow-up
33 Excellent (MEPI 100 points) Painless movement Flexion/Extension 140/0 Supination/Pronation 70/70
34
35 Female R. G., 28 years old Radial head fracture type Mason III, pain during movement, flexion/extension - 90/50, no rotation movement Bipolar radial head replacement type KPS with the head covered by metal
36 Preoperative X-ray Diagnosis radial head fracture type Mason III
37 Postoperative X-ray
38
39 Excellent (MEPI 100 points) Painless movement Flexion/Extension 130/0 Supination/Pronation 70/70
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44 We implante radial head prosthesis as a spacer allow to correct healing of soft tissue around the elbow joint which were injured during trauma. If after some time we decide for some reason to remove the implant we have a great chance to avoid such complications as valgus deformity of the elbow joint and subluxation of the DRUJ.
45 We have already decided to use the new generation KPS radial head prosthesis with the polymer head covered by metal it is our future So far 7 new generation KPS radial head prosthesis were implanted
46 Preoperative X-ray Diagnosis radial head fracture type Mason III
47
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49 Postoperative X-ray
50 8 weeks follow-up
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